Severe hand,foot and mouth disease has emerged as the important threat to lives of children in China in recent years. Enterovirus especially EV 71 is neurotropic pathogen, can cause encephalitis,brainstem encephalitis, which are considered to be related to some severe complications such as pulmonary edema and cardiovascular failure. Autonomic nervous system dysregulation and secondary excessive catecholamine release are thought to be the main mechanism. The key measures for decreasing mortality include optimal ventilatory and cardiovascular support as well as prevention of further brain injuries. The guideline should be used with cautions and clinical practice should be based on patient's conditions.